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Title: Carotid artery trauma: management based on mechanism of injury. Author: Fabian TC, George SM, Croce MA, Mangiante EC, Voeller GR, Kudsk KA. Journal: J Trauma; 1990 Aug; 30(8):953-61; discussion 961-3. PubMed ID: 2388306. Abstract: Fifty-six patients with carotid injuries were reviewed (35 penetrating and 21 blunt). Shock correlated with a profound neurologic deficit on admission (p less than 0.03) in those with penetrating wounds. Thirty-one percent had primary repair, 25% had interposition grafting, 17% were ligated, and 17% were anticoagulated. Two graft failures resulted in death. Three blunt common carotid injuries followed direct cervical soft-tissue trauma; 18 internal carotid (ICA) dissections followed apparent extreme neck extension or flexion. Seven had bilateral ICA dissections (39%); none of these died. All dissections were diagnosed by angiography prompted by a change in the neurologic examination or an initial neurologic deficit unexplained by CT scan. Seventy-one percent had major associated injuries; 43% intra-abdominal solid viscus, 24% pelvis/long bone fractures, and 24% cervical spine/facial fractures. Dissections were treated with anticoagulation; 60% improved, 23% were unchanged, and 17% deteriorated. It is concluded that interposition grafting should be avoided if possible following penetrating wounds; liberal angiography is warranted with incompatible CT findings following blunt trauma; and anticoagulation is safe and effective therapy for blunt carotid dissections.[Abstract] [Full Text] [Related] [New Search]